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TRAUMA CARE patients with severe injuries and warmer body temperatures tend to experience less hemorrhage than patients with cooler temperatures. This highlights the importance of avoiding the combination of trauma and hypothermia.13,14 When treating trauma patients, providers are encouraged to avoid unnecessarily or excessively exposing them to cooler environments, such as cold air, rain or snow, and provide a warmer environment if possible. Remove cold, wet clothing and replace it with dry blankets. These are simple yet impor- tant steps to support the patient's body temperature. If possible, avoid infusing cold or cool intravenous fluids, as this can contribute to reducing body tempera- ture. If allowed, active warming in the field may be initiated with caution. Overly aggressive rewarming can lead to pulmo- nary edema, reduced cough reflex and excessive bronchial secretions.2–4,10–14 Acidosis Acidosis is the result of excessive acid accumulation in body fluids. Causes include excessive acid in the blood, decreased clearance of acidic byprod- ucts, loss of bicarbonate from the blood, buildup of carbon dioxide in the blood resulting from poor lung function, and slow breathing.10,18–23 A normally healthy body maintains a balance of hydrogen ions (acids) through buffers. This involves the interaction of acids, bases and the proper pH level. The pH level is a measure of acidity rated on a scale of 0–14. Values less than 7.0 are considered acidic; those above 7.0 are basic (alkalotic). Normal pH of the blood is between 7.35–7.45. Recall that the buffer system includes plasma proteins, hemoglobin in red blood cells, sodium bicarbonate (NaHCO3 ) and carbonic acid (H2 CO3 The renal (kidneys) and pulmonary Figure 3: Buff ering System CO2 + H2O H2CO3 H+ + HCO 3 - Early compensated shock: increased respirations may lead to respiratory alkalosis Shock progresses: tissue hypoxia causes cells to shift from aerobic to anaerobic = lactic acidosis SOURCE: www.midcarolinarac.com/uploads/Trauma_ Triad of Death-Topley.pdf (lungs) systems are also important in maintaining homeostasis (Figure 3). A change in one component can influence any other.10,18–23 There are different forms of acidosis. ). Diabetic ketoacidosis, or DKA, develops when ketone bodies (acids) accumulate during uncontrolled diabetes. Lactic acidosis develops when metabolism occurs in the setting of low oxygen, resulting in the accumulation of lactic acid. Respiratory acidosis develops when there's excessive carbon dioxide, which can be caused by a decreased ability to EM1202S For More Information Circle 32 on Reader Service Card EMSWORLD.com | FEBRUARY 2012 47